HomeMy WebLinkAbout2021 Sign off Transmittal - Addition Yk TOWN OF YARMOUTH
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DEC 2 1 2021
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HEALTH DEPARTMENT
PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET
To be completed by Applicant:
Building Site Location: saS CRP1,1 Nk17. A1V,le. 09m 4Al2w‘.0.1 Z N
Proposed Improvement: $ o' - O' ADD1 t I oNA SAI o ib4.Cirkje
MI O v. $ci
Applicant: f\\M4 g t•-k.. Tel. No.:
Address: c 3 CA'Pl,A A1(LwW-alAi Date Filed:
**If you would like e-mail notification of sign off,please provide e-mail address: ACAN IC 14{N 4S P C,AAA i.C • Ct
Owner Name: AL AN, r2`IAN
Owner Address: 3 CA VI A t1-4, +12OAA 'Aerno J }{ Owner Tel. No.: -71g 6 $l
RESIDENTIAL AND/OR COMMERCIAL BUILDING
HEALTH DEPARTMENT: Determines Compliance to State and Town Regulations; i.e., Requirements
For Septage Disposal and other Public Health Activities.
=---- — Please submit three (3) copies of plans, to include:
(1.) Site Plan showing existing buildings,water line location,
and septic system location;
(2.) Floor plan labeling ALL rooms within building
HEALVH DEPT (all existing and proposed)—
Note:Floor plans not required for decks,sheds, windows,roofing;
(3.) If necessary, Title 5 application signed by licensed installer
with fee.
REVIEWED BY: DATE: 41 ` •
PLEASE NOTE
COMMENTS/CONDITIONS: